Widening rural–urban gap in life expectancy in China since COVID-19

Introduction Disparities in life expectancy between rural and urban populations are well established but how it varies with epidemics and pandemics remains poorly understood. We aimed to quantify the rural–urban differences in the mortality burden of COVID-19 and to contribute to understanding the d...
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Autor*in:	Chen Chen [verfasserIn] Xiaoying Zheng [verfasserIn] Shasha Han [verfasserIn] Binbin Su [verfasserIn] Yihao Zhao [verfasserIn]

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2023

Übergeordnetes Werk:	In: BMJ Global Health - BMJ Publishing Group, 2018, 8(2023), 9
Übergeordnetes Werk:	volume:8 ; year:2023 ; number:9

Links:	Link aufrufen Link aufrufen Link aufrufen Journal toc

DOI / URN:	10.1136/bmjgh-2023-012646

Katalog-ID:	DOAJ091090164

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520			\|a Introduction Disparities in life expectancy between rural and urban populations are well established but how it varies with epidemics and pandemics remains poorly understood. We aimed to quantify the rural–urban differences in the mortality burden of COVID-19 and to contribute to understanding the disparity trends in life expectancy between 1987 and 2021 in China.Methods We used monthly death counts from death registration systems. Rural–urban gap estimation and decomposition were carried out using period life tables to calculate life expectancy, the Arriaga decomposition technique to break down into age-specific and cause-specific mortality, and the Lee-Carter forecasts to estimate the expected gap.Results The rural–urban gap increased to 22.7 months (95% credible interval (CI) 19.6 to 25.8) in 2020 and further to 23.7 months (95% CI 19.6 to 26.7) in 2021, and was larger than expected under the continuation of the prepandemic trends. Compared with that in the recent 2003 SARS-CoV-2 epidemic and the 2009 influenza epidemic, excess rural–urban gaps in the COVID-19 pandemic changed from urban disadvantage to rural disadvantage, and the contributions shifted toward old age groups and circulatory diseases. Variations in the rural–urban gap since 1987 were positively correlated with the rural–urban disparity in public health expenditures, especially among ages <60 (p values <0.005).Conclusions Our findings identified a widening rural–urban gap in life expectancy since COVID-19, and a shifting trend towards old ages and circulatory diseases, disrupting the diminishing trend of the gap over 35 years. The findings highlight the unequal impact of the pandemic on different communities in terms of mortality burdens.
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allfields	10.1136/bmjgh-2023-012646 doi (DE-627)DOAJ091090164 (DE-599)DOAJ36023fd2aec5409eaa1971e82c42dd75 DE-627 ger DE-627 rakwb eng R5-920 RC109-216 Chen Chen verfasserin aut Widening rural–urban gap in life expectancy in China since COVID-19 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Introduction Disparities in life expectancy between rural and urban populations are well established but how it varies with epidemics and pandemics remains poorly understood. We aimed to quantify the rural–urban differences in the mortality burden of COVID-19 and to contribute to understanding the disparity trends in life expectancy between 1987 and 2021 in China.Methods We used monthly death counts from death registration systems. Rural–urban gap estimation and decomposition were carried out using period life tables to calculate life expectancy, the Arriaga decomposition technique to break down into age-specific and cause-specific mortality, and the Lee-Carter forecasts to estimate the expected gap.Results The rural–urban gap increased to 22.7 months (95% credible interval (CI) 19.6 to 25.8) in 2020 and further to 23.7 months (95% CI 19.6 to 26.7) in 2021, and was larger than expected under the continuation of the prepandemic trends. Compared with that in the recent 2003 SARS-CoV-2 epidemic and the 2009 influenza epidemic, excess rural–urban gaps in the COVID-19 pandemic changed from urban disadvantage to rural disadvantage, and the contributions shifted toward old age groups and circulatory diseases. Variations in the rural–urban gap since 1987 were positively correlated with the rural–urban disparity in public health expenditures, especially among ages <60 (p values <0.005).Conclusions Our findings identified a widening rural–urban gap in life expectancy since COVID-19, and a shifting trend towards old ages and circulatory diseases, disrupting the diminishing trend of the gap over 35 years. The findings highlight the unequal impact of the pandemic on different communities in terms of mortality burdens. Medicine (General) Infectious and parasitic diseases Xiaoying Zheng verfasserin aut Shasha Han verfasserin aut Binbin Su verfasserin aut Yihao Zhao verfasserin aut In BMJ Global Health BMJ Publishing Group, 2018 8(2023), 9 (DE-627)85645365X (DE-600)2851843-3 20597908 nnns volume:8 year:2023 number:9 https://doi.org/10.1136/bmjgh-2023-012646 kostenfrei https://doaj.org/article/36023fd2aec5409eaa1971e82c42dd75 kostenfrei https://gh.bmj.com/content/8/9/e012646.full kostenfrei https://doaj.org/toc/2059-7908 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 8 2023 9
spelling	10.1136/bmjgh-2023-012646 doi (DE-627)DOAJ091090164 (DE-599)DOAJ36023fd2aec5409eaa1971e82c42dd75 DE-627 ger DE-627 rakwb eng R5-920 RC109-216 Chen Chen verfasserin aut Widening rural–urban gap in life expectancy in China since COVID-19 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Introduction Disparities in life expectancy between rural and urban populations are well established but how it varies with epidemics and pandemics remains poorly understood. We aimed to quantify the rural–urban differences in the mortality burden of COVID-19 and to contribute to understanding the disparity trends in life expectancy between 1987 and 2021 in China.Methods We used monthly death counts from death registration systems. Rural–urban gap estimation and decomposition were carried out using period life tables to calculate life expectancy, the Arriaga decomposition technique to break down into age-specific and cause-specific mortality, and the Lee-Carter forecasts to estimate the expected gap.Results The rural–urban gap increased to 22.7 months (95% credible interval (CI) 19.6 to 25.8) in 2020 and further to 23.7 months (95% CI 19.6 to 26.7) in 2021, and was larger than expected under the continuation of the prepandemic trends. Compared with that in the recent 2003 SARS-CoV-2 epidemic and the 2009 influenza epidemic, excess rural–urban gaps in the COVID-19 pandemic changed from urban disadvantage to rural disadvantage, and the contributions shifted toward old age groups and circulatory diseases. Variations in the rural–urban gap since 1987 were positively correlated with the rural–urban disparity in public health expenditures, especially among ages <60 (p values <0.005).Conclusions Our findings identified a widening rural–urban gap in life expectancy since COVID-19, and a shifting trend towards old ages and circulatory diseases, disrupting the diminishing trend of the gap over 35 years. The findings highlight the unequal impact of the pandemic on different communities in terms of mortality burdens. Medicine (General) Infectious and parasitic diseases Xiaoying Zheng verfasserin aut Shasha Han verfasserin aut Binbin Su verfasserin aut Yihao Zhao verfasserin aut In BMJ Global Health BMJ Publishing Group, 2018 8(2023), 9 (DE-627)85645365X (DE-600)2851843-3 20597908 nnns volume:8 year:2023 number:9 https://doi.org/10.1136/bmjgh-2023-012646 kostenfrei https://doaj.org/article/36023fd2aec5409eaa1971e82c42dd75 kostenfrei https://gh.bmj.com/content/8/9/e012646.full kostenfrei https://doaj.org/toc/2059-7908 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 8 2023 9
allfields_unstemmed	10.1136/bmjgh-2023-012646 doi (DE-627)DOAJ091090164 (DE-599)DOAJ36023fd2aec5409eaa1971e82c42dd75 DE-627 ger DE-627 rakwb eng R5-920 RC109-216 Chen Chen verfasserin aut Widening rural–urban gap in life expectancy in China since COVID-19 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Introduction Disparities in life expectancy between rural and urban populations are well established but how it varies with epidemics and pandemics remains poorly understood. We aimed to quantify the rural–urban differences in the mortality burden of COVID-19 and to contribute to understanding the disparity trends in life expectancy between 1987 and 2021 in China.Methods We used monthly death counts from death registration systems. Rural–urban gap estimation and decomposition were carried out using period life tables to calculate life expectancy, the Arriaga decomposition technique to break down into age-specific and cause-specific mortality, and the Lee-Carter forecasts to estimate the expected gap.Results The rural–urban gap increased to 22.7 months (95% credible interval (CI) 19.6 to 25.8) in 2020 and further to 23.7 months (95% CI 19.6 to 26.7) in 2021, and was larger than expected under the continuation of the prepandemic trends. Compared with that in the recent 2003 SARS-CoV-2 epidemic and the 2009 influenza epidemic, excess rural–urban gaps in the COVID-19 pandemic changed from urban disadvantage to rural disadvantage, and the contributions shifted toward old age groups and circulatory diseases. Variations in the rural–urban gap since 1987 were positively correlated with the rural–urban disparity in public health expenditures, especially among ages <60 (p values <0.005).Conclusions Our findings identified a widening rural–urban gap in life expectancy since COVID-19, and a shifting trend towards old ages and circulatory diseases, disrupting the diminishing trend of the gap over 35 years. The findings highlight the unequal impact of the pandemic on different communities in terms of mortality burdens. Medicine (General) Infectious and parasitic diseases Xiaoying Zheng verfasserin aut Shasha Han verfasserin aut Binbin Su verfasserin aut Yihao Zhao verfasserin aut In BMJ Global Health BMJ Publishing Group, 2018 8(2023), 9 (DE-627)85645365X (DE-600)2851843-3 20597908 nnns volume:8 year:2023 number:9 https://doi.org/10.1136/bmjgh-2023-012646 kostenfrei https://doaj.org/article/36023fd2aec5409eaa1971e82c42dd75 kostenfrei https://gh.bmj.com/content/8/9/e012646.full kostenfrei https://doaj.org/toc/2059-7908 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 8 2023 9
allfieldsGer	10.1136/bmjgh-2023-012646 doi (DE-627)DOAJ091090164 (DE-599)DOAJ36023fd2aec5409eaa1971e82c42dd75 DE-627 ger DE-627 rakwb eng R5-920 RC109-216 Chen Chen verfasserin aut Widening rural–urban gap in life expectancy in China since COVID-19 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Introduction Disparities in life expectancy between rural and urban populations are well established but how it varies with epidemics and pandemics remains poorly understood. We aimed to quantify the rural–urban differences in the mortality burden of COVID-19 and to contribute to understanding the disparity trends in life expectancy between 1987 and 2021 in China.Methods We used monthly death counts from death registration systems. Rural–urban gap estimation and decomposition were carried out using period life tables to calculate life expectancy, the Arriaga decomposition technique to break down into age-specific and cause-specific mortality, and the Lee-Carter forecasts to estimate the expected gap.Results The rural–urban gap increased to 22.7 months (95% credible interval (CI) 19.6 to 25.8) in 2020 and further to 23.7 months (95% CI 19.6 to 26.7) in 2021, and was larger than expected under the continuation of the prepandemic trends. Compared with that in the recent 2003 SARS-CoV-2 epidemic and the 2009 influenza epidemic, excess rural–urban gaps in the COVID-19 pandemic changed from urban disadvantage to rural disadvantage, and the contributions shifted toward old age groups and circulatory diseases. Variations in the rural–urban gap since 1987 were positively correlated with the rural–urban disparity in public health expenditures, especially among ages <60 (p values <0.005).Conclusions Our findings identified a widening rural–urban gap in life expectancy since COVID-19, and a shifting trend towards old ages and circulatory diseases, disrupting the diminishing trend of the gap over 35 years. The findings highlight the unequal impact of the pandemic on different communities in terms of mortality burdens. Medicine (General) Infectious and parasitic diseases Xiaoying Zheng verfasserin aut Shasha Han verfasserin aut Binbin Su verfasserin aut Yihao Zhao verfasserin aut In BMJ Global Health BMJ Publishing Group, 2018 8(2023), 9 (DE-627)85645365X (DE-600)2851843-3 20597908 nnns volume:8 year:2023 number:9 https://doi.org/10.1136/bmjgh-2023-012646 kostenfrei https://doaj.org/article/36023fd2aec5409eaa1971e82c42dd75 kostenfrei https://gh.bmj.com/content/8/9/e012646.full kostenfrei https://doaj.org/toc/2059-7908 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 8 2023 9
allfieldsSound	10.1136/bmjgh-2023-012646 doi (DE-627)DOAJ091090164 (DE-599)DOAJ36023fd2aec5409eaa1971e82c42dd75 DE-627 ger DE-627 rakwb eng R5-920 RC109-216 Chen Chen verfasserin aut Widening rural–urban gap in life expectancy in China since COVID-19 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Introduction Disparities in life expectancy between rural and urban populations are well established but how it varies with epidemics and pandemics remains poorly understood. We aimed to quantify the rural–urban differences in the mortality burden of COVID-19 and to contribute to understanding the disparity trends in life expectancy between 1987 and 2021 in China.Methods We used monthly death counts from death registration systems. Rural–urban gap estimation and decomposition were carried out using period life tables to calculate life expectancy, the Arriaga decomposition technique to break down into age-specific and cause-specific mortality, and the Lee-Carter forecasts to estimate the expected gap.Results The rural–urban gap increased to 22.7 months (95% credible interval (CI) 19.6 to 25.8) in 2020 and further to 23.7 months (95% CI 19.6 to 26.7) in 2021, and was larger than expected under the continuation of the prepandemic trends. Compared with that in the recent 2003 SARS-CoV-2 epidemic and the 2009 influenza epidemic, excess rural–urban gaps in the COVID-19 pandemic changed from urban disadvantage to rural disadvantage, and the contributions shifted toward old age groups and circulatory diseases. Variations in the rural–urban gap since 1987 were positively correlated with the rural–urban disparity in public health expenditures, especially among ages <60 (p values <0.005).Conclusions Our findings identified a widening rural–urban gap in life expectancy since COVID-19, and a shifting trend towards old ages and circulatory diseases, disrupting the diminishing trend of the gap over 35 years. The findings highlight the unequal impact of the pandemic on different communities in terms of mortality burdens. Medicine (General) Infectious and parasitic diseases Xiaoying Zheng verfasserin aut Shasha Han verfasserin aut Binbin Su verfasserin aut Yihao Zhao verfasserin aut In BMJ Global Health BMJ Publishing Group, 2018 8(2023), 9 (DE-627)85645365X (DE-600)2851843-3 20597908 nnns volume:8 year:2023 number:9 https://doi.org/10.1136/bmjgh-2023-012646 kostenfrei https://doaj.org/article/36023fd2aec5409eaa1971e82c42dd75 kostenfrei https://gh.bmj.com/content/8/9/e012646.full kostenfrei https://doaj.org/toc/2059-7908 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 8 2023 9
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We aimed to quantify the rural–urban differences in the mortality burden of COVID-19 and to contribute to understanding the disparity trends in life expectancy between 1987 and 2021 in China.Methods We used monthly death counts from death registration systems. Rural–urban gap estimation and decomposition were carried out using period life tables to calculate life expectancy, the Arriaga decomposition technique to break down into age-specific and cause-specific mortality, and the Lee-Carter forecasts to estimate the expected gap.Results The rural–urban gap increased to 22.7 months (95% credible interval (CI) 19.6 to 25.8) in 2020 and further to 23.7 months (95% CI 19.6 to 26.7) in 2021, and was larger than expected under the continuation of the prepandemic trends. Compared with that in the recent 2003 SARS-CoV-2 epidemic and the 2009 influenza epidemic, excess rural–urban gaps in the COVID-19 pandemic changed from urban disadvantage to rural disadvantage, and the contributions shifted toward old age groups and circulatory diseases. Variations in the rural–urban gap since 1987 were positively correlated with the rural–urban disparity in public health expenditures, especially among ages &lt;60 (p values &lt;0.005).Conclusions Our findings identified a widening rural–urban gap in life expectancy since COVID-19, and a shifting trend towards old ages and circulatory diseases, disrupting the diminishing trend of the gap over 35 years. 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topic_title	R5-920 RC109-216 Widening rural–urban gap in life expectancy in China since COVID-19
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title	Widening rural–urban gap in life expectancy in China since COVID-19
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title_full	Widening rural–urban gap in life expectancy in China since COVID-19
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author_browse	Chen Chen Xiaoying Zheng Shasha Han Binbin Su Yihao Zhao
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title_sort	widening rural–urban gap in life expectancy in china since covid-19
callnumber	R5-920
title_auth	Widening rural–urban gap in life expectancy in China since COVID-19
abstract	Introduction Disparities in life expectancy between rural and urban populations are well established but how it varies with epidemics and pandemics remains poorly understood. We aimed to quantify the rural–urban differences in the mortality burden of COVID-19 and to contribute to understanding the disparity trends in life expectancy between 1987 and 2021 in China.Methods We used monthly death counts from death registration systems. Rural–urban gap estimation and decomposition were carried out using period life tables to calculate life expectancy, the Arriaga decomposition technique to break down into age-specific and cause-specific mortality, and the Lee-Carter forecasts to estimate the expected gap.Results The rural–urban gap increased to 22.7 months (95% credible interval (CI) 19.6 to 25.8) in 2020 and further to 23.7 months (95% CI 19.6 to 26.7) in 2021, and was larger than expected under the continuation of the prepandemic trends. Compared with that in the recent 2003 SARS-CoV-2 epidemic and the 2009 influenza epidemic, excess rural–urban gaps in the COVID-19 pandemic changed from urban disadvantage to rural disadvantage, and the contributions shifted toward old age groups and circulatory diseases. Variations in the rural–urban gap since 1987 were positively correlated with the rural–urban disparity in public health expenditures, especially among ages <60 (p values <0.005).Conclusions Our findings identified a widening rural–urban gap in life expectancy since COVID-19, and a shifting trend towards old ages and circulatory diseases, disrupting the diminishing trend of the gap over 35 years. The findings highlight the unequal impact of the pandemic on different communities in terms of mortality burdens.
abstractGer	Introduction Disparities in life expectancy between rural and urban populations are well established but how it varies with epidemics and pandemics remains poorly understood. We aimed to quantify the rural–urban differences in the mortality burden of COVID-19 and to contribute to understanding the disparity trends in life expectancy between 1987 and 2021 in China.Methods We used monthly death counts from death registration systems. Rural–urban gap estimation and decomposition were carried out using period life tables to calculate life expectancy, the Arriaga decomposition technique to break down into age-specific and cause-specific mortality, and the Lee-Carter forecasts to estimate the expected gap.Results The rural–urban gap increased to 22.7 months (95% credible interval (CI) 19.6 to 25.8) in 2020 and further to 23.7 months (95% CI 19.6 to 26.7) in 2021, and was larger than expected under the continuation of the prepandemic trends. Compared with that in the recent 2003 SARS-CoV-2 epidemic and the 2009 influenza epidemic, excess rural–urban gaps in the COVID-19 pandemic changed from urban disadvantage to rural disadvantage, and the contributions shifted toward old age groups and circulatory diseases. Variations in the rural–urban gap since 1987 were positively correlated with the rural–urban disparity in public health expenditures, especially among ages <60 (p values <0.005).Conclusions Our findings identified a widening rural–urban gap in life expectancy since COVID-19, and a shifting trend towards old ages and circulatory diseases, disrupting the diminishing trend of the gap over 35 years. The findings highlight the unequal impact of the pandemic on different communities in terms of mortality burdens.
abstract_unstemmed	Introduction Disparities in life expectancy between rural and urban populations are well established but how it varies with epidemics and pandemics remains poorly understood. We aimed to quantify the rural–urban differences in the mortality burden of COVID-19 and to contribute to understanding the disparity trends in life expectancy between 1987 and 2021 in China.Methods We used monthly death counts from death registration systems. Rural–urban gap estimation and decomposition were carried out using period life tables to calculate life expectancy, the Arriaga decomposition technique to break down into age-specific and cause-specific mortality, and the Lee-Carter forecasts to estimate the expected gap.Results The rural–urban gap increased to 22.7 months (95% credible interval (CI) 19.6 to 25.8) in 2020 and further to 23.7 months (95% CI 19.6 to 26.7) in 2021, and was larger than expected under the continuation of the prepandemic trends. Compared with that in the recent 2003 SARS-CoV-2 epidemic and the 2009 influenza epidemic, excess rural–urban gaps in the COVID-19 pandemic changed from urban disadvantage to rural disadvantage, and the contributions shifted toward old age groups and circulatory diseases. Variations in the rural–urban gap since 1987 were positively correlated with the rural–urban disparity in public health expenditures, especially among ages <60 (p values <0.005).Conclusions Our findings identified a widening rural–urban gap in life expectancy since COVID-19, and a shifting trend towards old ages and circulatory diseases, disrupting the diminishing trend of the gap over 35 years. The findings highlight the unequal impact of the pandemic on different communities in terms of mortality burdens.
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title_short	Widening rural–urban gap in life expectancy in China since COVID-19
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We aimed to quantify the rural–urban differences in the mortality burden of COVID-19 and to contribute to understanding the disparity trends in life expectancy between 1987 and 2021 in China.Methods We used monthly death counts from death registration systems. Rural–urban gap estimation and decomposition were carried out using period life tables to calculate life expectancy, the Arriaga decomposition technique to break down into age-specific and cause-specific mortality, and the Lee-Carter forecasts to estimate the expected gap.Results The rural–urban gap increased to 22.7 months (95% credible interval (CI) 19.6 to 25.8) in 2020 and further to 23.7 months (95% CI 19.6 to 26.7) in 2021, and was larger than expected under the continuation of the prepandemic trends. Compared with that in the recent 2003 SARS-CoV-2 epidemic and the 2009 influenza epidemic, excess rural–urban gaps in the COVID-19 pandemic changed from urban disadvantage to rural disadvantage, and the contributions shifted toward old age groups and circulatory diseases. Variations in the rural–urban gap since 1987 were positively correlated with the rural–urban disparity in public health expenditures, especially among ages &lt;60 (p values &lt;0.005).Conclusions Our findings identified a widening rural–urban gap in life expectancy since COVID-19, and a shifting trend towards old ages and circulatory diseases, disrupting the diminishing trend of the gap over 35 years. 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